Provider Demographics
NPI:1750455234
Name:SEVILLE EYE CENTER LLC
Entity Type:Organization
Organization Name:SEVILLE EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-279-3937
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:BLDG A STE 104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4259
Mailing Address - Country:US
Mailing Address - Phone:480-279-3937
Mailing Address - Fax:480-889-2948
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:BLDG A STE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4259
Practice Address - Country:US
Practice Address - Phone:480-279-3937
Practice Address - Fax:480-889-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ01104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539570Medicaid
AZ539570Medicaid
AZZ114202Medicare PIN